Pilot study using doxycycline‐releasing stents to ameliorate postoperative healing quality after sinus surgery

Abstract

Poor postoperative healing after sinus surgery is associated with high concentrations of matrix metalloproteinase-9 (MMP-9). The frontal recess is especially vulnerable to restenosis, and frontal sinus stents have been used to overcome this problem. However, the long-term success rate is still controversial and may be poor. In this perspective, we developed doxycycline (DC)-releasing stents, delivering the MMP-9 synthesis-suppressing agent locally to the frontal recess area. We evaluated postoperative MMP-9 levels, bacterial colonization, healing quality, and symptom scores in patients suffering from chronic rhinosinusitis with (CRSwNP) and without nasal polyposis (CRSsNP) (n=10) who underwent functional endoscopic sinus surgery during which the DC-releasing and placebo stents were placed. We found that MMP-9 concentrations were significantly lower at the side of the DC-releasing stent (3,414+/-582 ng/mL) compared with the contralateral placebo stent (9,172+/-2,564 ng/mL) (p<0.05) at month 3 postsurgery. DC stents adequately suppressed bacterial growth compared with placebo stents. Furthermore, the visual analog scale (VAS) for the frontal region was significantly better (mean value 75.1 vs. 52.8, p<0.001) compared with its placebo counterpart. We conclude that compared with placebo stents, DC-releasing stents significantly lowered MMP-9 concentrations and bacterial colonization locally, and improved postoperative healing quality after functional endoscopic sinus surgery, as demonstrated by visual analog scale and ostial closure.

Early postoperative care following endoscopic sinus surgery: an evidence‐based review with recommendations

“…This review identified 3 studies evaluating the role of drug‐eluting spacers and stents after ESS (Table 10). 48–50 One study evaluated a frontal sinus drug eluting stent, while the other 2 studies evaluated ethmoid cavity drug eluting spacers. The study by Huvenne et al48 (level 3b) demonstrated that a frontal sinus stent eluting doxycycline could improve local frontal sinus symptoms and reduce matrix metalloproteinase (MMP)‐9 levels, a molecule thought to contribute to osteoneogenesis.…”

Chronic rhinosinusitis with and without nasal polyps: What is the difference?

“…Indeed, patients with high concentrations of MMP-9 (and probably other MMPs, not balanced by TIMPs) in the preoperative and late postoperative period suffered from poor healing. Moreover, recent data support the hypothesis that MMP-9 can serve as a target for therapeutic intervention to achieve better healing quality [50].…”

Rhinosinusitis and Asthma: A Link for Asthma Severity

“…Doxycycline significantly decreased nasal polyp size for 12 weeks compared with placebo and significantly reduced eosinophilic and neutrophilic inflammation markers as well as neutrophilderived MMP-9 levels in nasal secretions. Doxycycline suppressed bacterial growth, including biofilm formation of S. aureus, in another study using local application [38]. Appropriate studies in comorbid asthma are lacking thus far.…”